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1.
BMJ ; 372: m4957, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504472

RESUMO

OBJECTIVE: To examine county level associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates. DESIGN: Panel regression methods. SETTING: 812 counties in the United States in the 23 states that allowed legal forms of cannabis dispensaries to operate by the end of 2017. PARTICIPANTS: The study used US mortality data from the Centers for Disease Control and Prevention combined with US census data and data from Weedmaps.com on storefront dispensary operations. Data were analyzed at the county level by using panel regression methods. MAIN OUTCOME MEASURE: The main outcome measures were the log transformed, age adjusted mortality rates associated with all opioid types combined, and with subcategories of prescription opioids, heroin, and synthetic opioids other than methadone. The associations of medical dispensary and recreational dispensary counts with age adjusted mortality rates were also analyzed. RESULTS: County level dispensary count (natural logarithm) is negatively related to the log transformed, age adjusted mortality rate associated with all opioid types (ß=-0.17, 95% confidence interval -0.23 to -0.11). According to this estimate, an increase from one to two storefront dispensaries in a county is associated with an estimated 17% reduction in all opioid related mortality rates. Dispensary count has a particularly strong negative association with deaths caused by synthetic opioids other than methadone (ß=-0.21, 95% confidence interval -0.27 to -0.14), with an estimated 21% reduction in mortality rates associated with an increase from one to two dispensaries. Similar associations were found for medical versus recreational storefront dispensary counts on synthetic (non-methadone) opioid related mortality rates. CONCLUSIONS: Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl. While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates. This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.


Assuntos
Analgésicos Opioides/envenenamento , Comércio/estatística & dados numéricos , Overdose de Drogas/mortalidade , Uso da Maconha/legislação & jurisprudência , Maconha Medicinal , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio/legislação & jurisprudência , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Análise de Regressão , Estados Unidos/epidemiologia
2.
J Subst Abuse Treat ; 122: 108210, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33509413

RESUMO

Opioid-related overdoses and the coronavirus disease 2019 (COVID-19) represent two of the deadliest crises in United States' history and together constitute a syndemic. The intersecting risks of this syndemic underscore the urgent need to implement effective opioid use disorder (OUD) treatments that are sustainable amid COVID-19 mitigation strategies. In response to new federal guidance released during the pandemic, opioid treatment programs (OTPs) have quickly innovated to implement new systems of medication delivery. OTPs rapid implementation of new medication delivery models defies conventional wisdom about the pace of research transfer. As part of an ongoing cluster-randomized type 3 hybrid trial evaluating strategies to implement contingency management (CM), select staff of eight OTPs had been trained to deliver CM and were in the midst of receiving ongoing implementation support. As COVID-19 emerged, all eight OTPs mirrored trends in the addiction field and effectively adapted to federal/state demands to implement new methods of medication delivery. However, over the past few months, necessity has arguably been the mother of implementation. We have observed greater variance among these OTPs' success with the additional implementation of adjunctive CM. The speed and variability of innovation raises novel questions about drivers of implementation. We argue that the mother of the next innovation should be a public call for a progressive, thoughtful set of public health policies and other external setting levers to address the needs of those with OUD and the OTPs that serve them.


Assuntos
Transtornos Relacionados ao Uso de Opioides/terapia , Pandemias , Assistência Ambulatorial , Buprenorfina/uso terapêutico , Ensaios Clínicos Fase III como Assunto , Overdose de Drogas/prevenção & controle , Medicina Baseada em Evidências , Implementação de Plano de Saúde , Humanos , Tratamento de Substituição de Opiáceos , Centros de Tratamento de Abuso de Substâncias
3.
J Subst Abuse Treat ; 122: 108219, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33353790

RESUMO

Opioid treatment programs (OTPs) operate within a rigid set of clinical guidelines and regulations that specify the number of required OTP visits for supervised administration of methadone. To ensure physical distancing in light of COVID-19, the federal government loosened regulations to allow for additional flexibility. As OTP providers in the Bronx, NY, caring for more than 3600 patients in the epicenter of both the overdose and COVID-19 pandemics, we describe how our clinical practice changed with COVID-19. We halted toxicology testing, and to promote physical distancing and prevent interruptions in access to treatment for medications for opioid use disorder (MOUD), we drastically increased unsupervised take-home doses of MOUD. Within two weeks, we reduced the proportion of patients with 5-6 OTP visits per week from 47.2% to 9.4%. To guide treatment decision-making, we shifted focus from toxicology tests to other patient-centered measures, such as engagement in care and patient goals. In the initial three months, our patients experienced six nonfatal overdoses, no fatal overdoses, and 20 deaths attributable to COVID-19. This experience provides an opportunity to re-imagine care in OTPs going forward. We advocate that OTPs rely less on toxicology testing and more on the other patient-centered measures to guide decisions about distribution of take-home doses of MOUD. To minimize financial risk to OTPs and facilitate their transition to a more flexible model of care, we advocate for the reassessment of OTP reimbursement models.


Assuntos
Transtornos Relacionados com Narcóticos/reabilitação , Pandemias , Assistência Centrada no Paciente/organização & administração , Agendamento de Consultas , Buprenorfina , Tomada de Decisão Clínica , Overdose de Drogas/epidemiologia , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Metadona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados com Narcóticos/diagnóstico , Cidade de Nova Iorque , Tratamento de Substituição de Opiáceos , Detecção do Abuso de Substâncias
4.
Am J Public Health ; 111(2): 215-218, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33351661

RESUMO

The Buprenorphine Nurse Care Manager Initiative (BNCMI) sought to increase access to opioid use disorder treatment in underserved New York City populations by expanding buprenorphine treatment capacity in safety-net primary care clinics.During 2016 to 2020, BNCMI added 116 new buprenorphine providers across 27 BNCMI clinics, and 1212 patients were enrolled; most patients identified as Latinx or Hispanic and were Medicaid beneficiaries.BNCMI increased access to buprenorphine, reached underserved populations, and is part of the New York City Health Department's multipronged approach to reducing opioid overdose deaths.


Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Acesso aos Serviços de Saúde , Tratamento de Substituição de Opiáceos , Provedores de Redes de Segurança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/enfermagem , Atenção Primária à Saúde , Saúde Pública , Adulto Jovem
5.
J Subst Abuse Treat ; 119: 108153, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032862

RESUMO

The global coronavirus disease 2019 (COVID-19) will exacerbate the negative health outcomes associated with the concurrent opioid overdose crisis in North America. COVID-19 brings unique challenges for practitioners who provide opioid use disorder (OUD) care. The majority of overdose deaths in the Canadian province of British Columbia occur in housing environments. Some supportive housing environments in Vancouver, British Columbia, have on-site primary care and substance use disorder treatment clinics. Some of these housing environments also include supervised consumption services. These housing environments needed to make adjustments to their care to adhere to COVID-19 physical distancing measures. Such adjustments included a pandemic withdrawal management program to provide patients with a pharmaceutical grade alternative to the toxic illicit drug supply, which allow patients to avoid the heightened overdose risk while using illicit drugs alone or potentially exposing themselves to COVID-19 while using drugs in a group setting. Other modifications to the OUD care continuum included modified supervised injection spaces to adhere to physical distancing, the use of personal protective equipment for overdose response, virtual platforms for clinical encounters, writing longer prescriptions, and providing take-home doses to promote opioid agonist treatment retention. These strategies aim to mitigate indoor overdose risk while also addressing COVID-19 risks.


Assuntos
Analgésicos Opioides/envenenamento , Infecções por Coronavirus/prevenção & controle , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Analgésicos Opioides/provisão & distribução , Colúmbia Britânica , Overdose de Drogas/epidemiologia , Habitação , Humanos , Drogas Ilícitas/envenenamento , Drogas Ilícitas/provisão & distribução , Programas de Troca de Agulhas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Equipamento de Proteção Individual , Risco , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos
6.
J Stud Alcohol Drugs ; 81(5): 556-560, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33028465

RESUMO

People who use drugs (PWUD) face concurrent public health emergencies from overdoses, HIV, hepatitis C, and COVID-19, leading to an unprecedented syndemic. Responses to PWUD that go beyond treatment--such as decriminalization and providing a safe supply of pharmaceutical-grade drugs--could reduce impacts of this syndemic. Solutions already implemented for COVID-19, such as emergency safe-supply prescribing and providing housing to people experiencing homelessness, must be sustained once COVID-19 is contained. This pandemic is not only a public health crisis but also a chance to develop and maintain equitable and sustainable solutions to the harms associated with the criminalization of drug use.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sindemia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Criminosos , Overdose de Drogas/complicações , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Serviços Médicos de Emergência , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Hepatite C/complicações , Hepatite C/prevenção & controle , Habitação , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Prescrições , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados Unidos/epidemiologia , United States Public Health Service
7.
PLoS One ; 15(9): e0238618, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915834

RESUMO

INTRODUCTION: British Columbia's (BC) Take-Home Naloxone (THN) program provides naloxone to bystanders for use in cases of suspected opioid overdose. This study seeks to provide trends and analysis from the provincial BC THN program since inception in 2012 to the end of 2018. MATERIALS AND METHODS: BC THN shipment and distribution records from 2012-2018 were retrieved. Frequency distributions were used to describe characteristics of individuals accessing the program. To evaluate correlates of distribution after the addition of hundreds of pharmacy distribution sites, an analytic sample was limited to records from 2018, and multivariate logistic regression was used to evaluate correlates of collecting naloxone at a pharmacy site. RESULTS: Since program inception to the end of 2018, there were 398,167 naloxone kits shipped to distribution sites, 149,999 kits reported distributed, and 40,903 kits reported used to reverse an overdose in BC. There was a significant increasing trend in the number of naloxone kits used to reverse an overdose over time (p<0.01), and more than 90% of kits that were reported used were distributed to persons at risk of an overdose. Individuals not personally at risk of overdose had higher odds of collecting naloxone at a pharmacy site, compared to other community sites (including harm reduction supply distribution sites, peer led organizations, drop-in centers, and supportive housing sites) (Adjusted Odds Ratio (AOR): 2.69; 95% CI: 2.50-2.90). CONCLUSIONS: This study documents thousands of opioid overdose reversals facilitated through the BC THN program. While those at highest risk of overdose may preferentially access naloxone through community sites, naloxone distribution through pharmacies has allowed the BC THN program to expand dramatically, increasing naloxone availability through longer opening hours on evenings and weekends. and in rural and remote regions. A diversity of naloxone distribution sites and strategies is crucial to prevent rising opioid overdose deaths.


Assuntos
Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Colúmbia Britânica/epidemiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Naloxona/efeitos adversos , Antagonistas de Entorpecentes/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Farmácias/tendências
9.
Milbank Q ; 98(3): 700-746, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32808709

RESUMO

Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. CONTEXT: Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. METHODS: In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. FINDINGS: De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. CONCLUSIONS: Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/etiologia , Determinantes Sociais da Saúde , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Redução do Dano , Humanos , Modelos Teóricos , Epidemia de Opioides/mortalidade , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Fatores de Risco , Estados Unidos/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 69(33): 1117-1121, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32817603

RESUMO

Syringe service programs (SSPs), which provide access to sterile syringes and other injection equipment and their safe disposal after use,* represent a highly successful human immunodeficiency virus (HIV) prevention intervention. SSPs are associated with a 58% reduction in the incidence of HIV infection among persons who inject drugs (1). In addition, SSPs have led efforts to prevent opioid overdose deaths by integrating evidence-based opioid overdose education and naloxone distribution (OEND) programs (2-4). OEND programs train laypersons to respond during overdose events and provide access to naloxone and directions for drug delivery (2-4). SSPs are ideal places for OEND because they provide culturally relevant services designed to reach persons at high risk for experiencing or observing an opioid overdose. A 2013 survey found that only 55% of SSPs in the United States had implemented OEND (5). To characterize current implementation of OEND among SSPs, and to describe the current reach (i.e., the ratio of persons who received naloxone per opioid overdose death and the ratio of naloxone doses distributed per opioid overdose death) of SSP-based OEND programs by U.S. Census division,† a survey of known U.S. SSPs was conducted in 2019, which found that 94% of SSPs had implemented OEND. In addition, the reach of SSP-based OEND programs varied by U.S. Census division. Scaling up of SSP-based OEND delivery programs could be a critical component for areas of the country with high opioid overdose death rates and low reach.


Assuntos
Overdose de Drogas/prevenção & controle , Educação em Saúde/organização & administração , Naloxona/provisão & distribução , Programas de Troca de Agulhas/organização & administração , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Overdose de Drogas/mortalidade , Humanos , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/mortalidade , Estados Unidos/epidemiologia
12.
Am J Public Health ; 110(8): 1235-1241, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552015

RESUMO

Opioid use disorder (OUD) and opioid overdose deaths (OODs) are prevalent among US workers, but work-related factors have not received adequate attention as either risk factors or opportunities for OOD prevention. Higher prevalence of OOD in those with heavy physical jobs, more precarious work, and limited health care benefits suggest work environment and organizational factors may predispose workers to the development of OUD.Organizational policies that reduce ergonomic risk factors, respond effectively to employee health and safety concerns, provide access to nonpharmacologic pain management, and encourage early substance use treatment are important opportunities to improve outcomes. Organizational barriers can limit disclosure of pain and help-seeking behavior, and opioid education is not effectively integrated with workplace safety training and health promotion programs.Policy development at the employer, government, and association levels could improve the workplace response to workers with OUD and reduce occupational risks that may be contributing factors.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/prevenção & controle , Saúde do Trabalhador , Transtornos Relacionados ao Uso de Opioides , Política Organizacional , Local de Trabalho/estatística & dados numéricos , Promoção da Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/mortalidade , Estados Unidos/epidemiologia
13.
Am J Public Health ; 110(8): 1191-1197, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552023

RESUMO

Prescription drug monitoring programs (PDMPs) have become a widely embraced policy to address the US opioid crisis. Despite mixed scientific evidence on their effectiveness at improving health and reducing overdose deaths, 49 states and Washington, DC have adopted PDMPs, and they have received strong bipartisan legislative support. This article explores the history of PDMPs, tracking their evolution from paper-based administrative databases in the early 1900s to modern-day electronic systems that intervene at the point of care. We focus on two questions: how did PDMPs become so widely adopted in the United States, and how did they gain popularity as an intervention in the contemporary opioid crisis? Through this historical approach, we evaluate what PDMPs reflect about national drug policy and broader cultural understandings of substance use disorder in the United States today. (Am J Public Health. 2020;110:1191-1197. 10.2105/AJPH.2020.305696).


Assuntos
Uso Indevido de Medicamentos sob Prescrição , Programas de Monitoramento de Prescrição de Medicamentos/história , Saúde Pública , Analgésicos Opioides/efeitos adversos , Overdose de Drogas/prevenção & controle , História do Século XX , História do Século XXI , Humanos , Políticas , Uso Indevido de Medicamentos sob Prescrição/história , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Estados Unidos
15.
PLoS One ; 15(5): e0229208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32438390

RESUMO

The primary objective of this study was to examine the impacts associated with implementation of overdose preventions sites (OPSs) in Victoria, Canada during a declared provincial public health overdose emergency. A rapid case study design was employed with three OPSs constituting the cases. Data were collected through semi-structured interviews with 15 staff, including experiential staff, and 12 service users. Theoretically, we were informed by the Consolidated Framework for Implementation Research. This framework, combined with a case study design, is well suited for generating insight into the impacts of an intervention. Zero deaths were identified as a key impact and indicator of success. The implementation of OPSs increased opportunities for early intervention in the event of an overdose, reducing trauma for staff and service users, and facilitated organizational transitions from provision of safer supplies to safer spaces. Providing a safer space meant drug use no longer needed to be concealed, with the effect of mitigating drug related stigma and facilitating a shift from shame and blame to increasing trust and development of relationships with increased opportunities to provide connections to other services. These impacts were achieved with few new resources highlighting the commitment of agencies and harm reduction workers, particularly those with lived experience, in achieving beneficial impacts. Although mitigating harms of overdose, OPSs do not address the root problem of an unsafe drug supply. OPSs are important life-saving interventions, but more is needed to address the current contamination of the illicit drug supply including provision of a safer supply.


Assuntos
Overdose de Drogas/prevenção & controle , Emergências/epidemiologia , Drogas Ilícitas/envenenamento , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Adulto , Colúmbia Britânica , Feminino , Humanos , Masculino , Programas de Troca de Agulhas/métodos , Estudos de Casos Organizacionais/métodos , Saúde Pública/métodos
16.
Value Health ; 23(4): 451-460, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32327162

RESUMO

OBJECTIVES: To determine the cost-effectiveness of pharmacy-based intranasal naloxone distribution to high-risk prescription opioid (RxO) users. METHODS: We developed a Markov model with an attached tree for pharmacy-based naloxone distribution to high-risk RxO users using 2 approaches: one-time and biannual follow-up distribution. The Markov structure had 6 health states: high-risk RxO use, low-risk RxO use, no RxO use, illicit opioid use, no illicit opioid use, and death. The tree modeled the probability of an overdose happening, the overdose being witnessed, naloxone being available, and the overdose resulting in death. High-risk RxO users were defined as individuals with prescription opioid doses greater than or equal to 90 morphine milligram equivalents (MME) per day. We used a monthly cycle length, lifetime horizon, and US healthcare perspective. Costs (2018) and quality-adjusted life-years (QALYs) were discounted 3% annually. Microsimulation was performed with 100 000 individual trials. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: One-time distribution of naloxone prevented 14 additional overdose deaths per 100 000 persons, with an incremental cost-effectiveness ratio (ICER) of $56 699 per QALY. Biannual follow-up distribution led to 107 additional lives being saved with an ICER of $84 799 per QALY compared with one-time distribution. Probabilistic sensitivity analyses showed that a biannual follow-up approach would be cost-effective 50% of the time at a willingness-to-pay (WTP) threshold of $100 000 per QALY. Naloxone effectiveness and proportion of overdoses witnessed were the 2 most influential parameters for biannual distribution. CONCLUSION: Both one-time and biannual follow-up naloxone distribution in community pharmacies would modestly reduce opioid overdose deaths and be cost-effective at a WTP of $100 000 per QALY.


Assuntos
Analgésicos Opioides/administração & dosagem , Overdose de Drogas/prevenção & controle , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Administração Intranasal , Analgésicos Opioides/economia , Analgésicos Opioides/envenenamento , Serviços Comunitários de Farmácia/economia , Serviços Comunitários de Farmácia/organização & administração , Análise Custo-Benefício , Custos de Medicamentos , Overdose de Drogas/economia , Humanos , Cadeias de Markov , Naloxona/economia , Antagonistas de Entorpecentes/economia , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/economia , Anos de Vida Ajustados por Qualidade de Vida , Risco
17.
Ann Emerg Med ; 76(3): 318-327, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32241746

RESUMO

Despite consensus recommendations from the American College of Emergency Physicians (ACEP), the Centers for Disease Control and Prevention, and the surgeon general to dispense naloxone to discharged ED patients at risk for opioid overdose, there remain numerous logistic, financial, and administrative barriers to implementing "take-home naloxone" programs at individual hospitals. This article describes the recent collective experience of 7 Chicago-area hospitals in implementing take-home naloxone programs. We highlight key barriers, such as hesitancy from hospital administrators, lack of familiarity with relevant rules and regulations in regard to medication dispensing, and inability to secure a supply of naloxone for dispensing. We also highlight common facilitators of success, such as early identification of a "C-suite" champion and the formation of a multidisciplinary team of program leaders. Finally, we provide recommendations that will assist emergency departments planning to implement their own take-home naloxone programs and will inform policymakers of specific needs that may facilitate dissemination of naloxone to the public.


Assuntos
Overdose de Drogas/prevenção & controle , Serviço Hospitalar de Emergência/legislação & jurisprudência , Implementação de Plano de Saúde/legislação & jurisprudência , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Alta do Paciente , Chicago , Humanos , Governo Estadual
19.
Am J Public Health ; 110(6): 833-835, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298171

RESUMO

"The Molson" is a low-barrier, peer-staffed, supervised consumption site located in Vancouver, Canada. In addition to overdose response, this site offers drug checking and a colocated injectable hydromorphone treatment program, and it distributes tablet and liquid hydromorphone to service users at high risk of overdose. Our evaluation suggests benefits of this program in creating service continuums and preventing overdose deaths. From September 2017 to August 2019, the site had 128 944 visits, reversed 770 overdoses, and had no overdose deaths.


Assuntos
Centros Comunitários de Saúde , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides/terapia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Colúmbia Britânica , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Redução do Dano , Humanos , Hidromorfona/administração & dosagem , Hidromorfona/uso terapêutico , Saúde Pública
20.
Am J Public Health ; 110(6): 881-887, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298179

RESUMO

Objectives. To examine early impacts of laws that require naloxone to be prescribed to patients at increased overdose risk.Methods. Using data from 2014 to 2018 from a large pharmacy chain, CVS Pharmacy, we examined the effects of naloxone-prescribing mandates 90 days before and after they took effect in Arizona, Florida, Rhode Island, Vermont, and Virginia. We compared the number of naloxone doses initiated directly by prescribers and by pharmacy standing order, prescriber specialty, pharmacies dispensing, and payor type by applying linear models and the χ2 test.Results. Naloxone-prescribing mandates increased pharmacy naloxone provision 255% from 90 days before to after implementation. This approach appeared to engage more prescribers (1028 before to 4285 after), complement ongoing naloxone provision under pharmacy standing orders, expand geographic reach (from 40% to 80% of pharmacies dispensing), and broaden the naloxone payor mix in 4 (P < .05) of 5 states.Conclusions. Mandating the prescribing of naloxone quickly expands access to this life-saving medication for more people in more places. Other states should consider mandating the coprescription of naloxone to individuals at increased risk of overdose.


Assuntos
Overdose de Drogas , Prescrições de Medicamentos/estatística & dados numéricos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Naloxona , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/prevenção & controle , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Naloxona/provisão & distribução , Naloxona/uso terapêutico , Estados Unidos
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